Relationship Between Surgery Timing and Hidden Blood Loss in Proximal Femoral Nailing of Pertrochanteric Fractures in Elderly Patients

Abstract

Objectives. Pertrochanteric fractures, commonly incurred by the elderly from low-energy falls, require surgical management. Visible blood loss in the perioperative period is inconsistent with the big drop in hemoglobin seen postoperatively. This discrepancy is attributed to the hidden blood loss (HBL), which must be anticipated in anemia management. This study aimed to determine if the amount of HBL in elderly patients with pertrochanteric femur fractures treated with short proximal femoral anti-rotation nailing (PFNa) is affected by the delay in time to surgery. Methodology. This is a detailed cross-sectional study from a single institution. Two hundred and ten patients admitted and operated on from January 2017 to December 2019 at an orthopedic specialty hospital were included in the study. Patient’s age, sex, AO classification, weight, height, operative time, and hematocrit levels on admission, within 7 days before surgery and immediately postoperatively; visual blood loss and blood transfused were reviewed and retrieved from medical records. Cases were grouped into early (<30 days) or late (≥ 30 days) surgery groups based on the time from injury to surgery. Total blood loss and hidden blood loss were computed based on the data. Results. There was no significant difference in the demographic and clinical characteristics of patients in both groups. Mean HBL was 113.65 mL (± 99.25 mL) in the early surgery group and 95.32 mL (± 111.79 mL) in the late surgery group. Mean HBLs were 31.47% and 27.88% of the total blood loss computed for the early and late surgery groups, respectively. Using an independent t-test, we noted no significant difference in the HBLs between the groups (p = 0.22). Conclusion. Delay in treatment of pertrochanteric fractures fixed with short proximal femoral anti-rotation nailing did not significantly affect the amount of hidden blood loss. However, the computed hidden losses, which make up a large percentage of the total blood loss, should be considered in the postoperative management of anemia.

Keywords

• blood loss
• surgical
• operative time
• treatment delay
• proximal femur fractures
• fracture fixation